Will a New Medicare Disclosure Work?

by Jeff Sovern

As reported by the Times last week, patients who are held at a hospital for "observation," even if that observation lasts days, but not formally admitted, and later released to a nursing home, won't have their stay in the nursing home covered by Medicare. That stay can cost tens of thousands of dollars. So Congress passed a law mandating disclosure of that fact. So far, so good. But there's a problem.  Remember that patients get this disclosure in a hospital, when they may be seriously ill and not at their best, and that they may also be deluged by other forms.  Will they pay attention to this disclosure, in light of the evidence that consumers largely disregard or misinterpret disclosures?  Some evidence even indicates that consumers can't absorb disclosures in the medical context.   Here's the new disclosure, which spans two pages (the formatting didn't survive pasting in, but you can view it here):

(Hospitals may include contact information or logo here)

Form CMS 10611-MOON Expiration xx/xx/xxxx OMB approval 0938-xxxx

Medicare Outpatient Observation Notice

Patient name: Patient number:

You’re a hospital outpatient receiving observation services. You are not an inpatient because:

Being an outpatient may affect what you pay in a hospital:

• When you’re a hospital outpatient, your observation stay is covered under Medicare Part B.

• For Part B services, you generally pay:

o A copayment for each outpatient hospital service you get. Part B copayments may vary by type of service.

o 20% of the Medicare-approved amount for most doctor services, after the Part B deductible.

Observation services may affect coverage and payment of your care after you leave thehospital:

• If you need skilled nursing facility (SNF) care after you leave the hospital, Medicare Part A will only cover SNF care if you’ve had a 3-day minimum, medically necessary, inpatient hospital stay for a related illness or injury. An inpatient hospital stay begins the day the hospital admits you as an inpatient based on a doctor’s order and doesn’t include the day you’re discharged.

• If you have Medicaid, a Medicare Advantage plan or other health plan, Medicaid or the plan may have different rules for SNF coverage after you leave the hospital. Check with Medicaid or your plan.

NOTE: Medicare Part A generally doesn’t cover outpatient hospital services, like an observation stay. However, Part A will generally cover medically necessary inpatient services if the hospital admits you as an inpatient based on a doctor’s order. In most cases, you’ll paya one-time deductible for all of your inpatient hospital services for the first 60 days you’re in a hospital.

If you have any questions about your observation services, ask the hospital staff member giving you this notice or the doctor providing your hospital care. You can also ask to speak with someone from the hospital’s utilization or discharge planning department.

You can also call 1-800-MEDICARE(1-800-633-4227). TTY users should call 1-877-486-2048.

(Hospitals may include contact information or logo here)

Form CMS 10611-MOON Expiration xx/xx/xxxx OMB approval 0938-xxxx

Your costs for medications:

Generally, prescription and over-the-counter drugs, including "self-administered drugs," you get in a hospital outpatient setting (like an emergency department) aren’t covered by Part B. "Self- administered drugs" are drugs you’d normally take on your own. For safety reasons, many hospitals don’t allow youto take medications brought from home. If you have a Medicare prescription drug plan (Part D), your planmay help you pay for these drugs. You’ll likely need to pay out-of- pocket for thesedrugs and submit a claim to your drug plan for a refund. Contact your drug plan for more information.

If you’re enrolled in a Medicare Advantage plan (like an HMO or PPO) or other Medicare health plan (Part C), your costs and coverage may be different. Check with your plan to find out about coveragefor outpatient observation services.

If you’re a Qualified Medicare Beneficiary through your state Medicaid program, you can’t be billed for Part A or Part B deductibles, coinsurance, and copayments.

Additional Information (Optional):

Please sign below to show you received and understand this notice.

Signature of Patient or Representative Date / Time

CMS does not discriminate in its programs and activities. To request this publication in alternative format, please call: 1-800-MEDICARE or email:AltFormatRequest@cms.hhs.gov.

Will patients take that in?  I have serious doubts. The hospital is also required to notify the patient orally, which may be more helpful, but I wonder how many consumers will realize that the cost is on them for this one.  Why not a one-sentence disclosure, or at least put in bold at the top something like: ""Medicare won't pay for your nursing home stay if you need one; you would have to." And by all means, test it on patients to see if they get it.


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